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H
Medicare Auditor I
Horizon Connect @ Wall BCBSNJ. Review and verify data integrity of Medicare files .
Posted 11/12/2026full-timeRemote • New Jersey • United StatesJuniorMid-Level💰 $50,100 - $67,095 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare regulations and claims processing, with strong capabilities in data integrity verification and system updates. Proficient in utilizing various internal systems and tools to support Medicare-related inquiries and reporting.
Highest-signal resume keywords
Medicare KnowledgeClaims Processing ExperienceMedicare Secondary Payer RegulationsNMS and Nasco ProficiencyStrong Computer Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingData Integrity VerificationSystem UpdatesResearch and Benefits ApplicationMicrosoft ExcelMicrosoft AccessMicrosoft Word
Soft Skills
MultitaskingInterpersonal SkillsCritical ThinkingOrganizational SkillsWritten and Verbal Skills
Tools & Technologies
NascoNCompassNMSFileNetCirrusSales Internal Systems NAEGSCPL
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
MedicareEnd-Stage Renal DiseaseCMS RegulationsRecovery OpportunitiesMSP Inventory Reporting
About the role
Key responsibilities & impact- Review and verify data integrity of Medicare files
- Determine primacy and coordinate system updates as needed
- Review End-Stage Renal Disease cases and determine Medicare primacy
- Review recovery opportunities identified by vendors and determine whether identified recoveries are valid
- Respond to Medicare-related questions from Account Managers, brokers, groups, members, and other customers
- Support MSP inventory reporting, MRM hierarchy-error review, and Claimstop/PLOG review
- Use Medicare data, group size, and working status to determine whether Horizon or Medicare is primary
- Process claims to repay Medicare or the Treasury Department following CMS Regulations
- Update tracking system accordingly
- Research and apply benefits as needed
- Read and understand New Membership System (NMS) and Nasco
- Perform other related tasks as assigned by management
Requirements
What you’ll need- High School Diploma/GED required
- Minimum of 2 years experience in processing and adjusting claims
- Knowledge of Medicare
- Knowledge of Medicare Secondary Payer regulations
- Knowledge of NMS and Nasco
- Knowledge of Sales internal systems NAEGS and CPL
- Strong Computer Skills
- Multitasking, strong Interpersonal skills, critical thinking, organizational skills and strong Written and Verbal Skills
- Microsoft Excel
- Microsoft Access
- Microsoft Word
- Experience with Nasco, NCompass, NMS, FileNet, and Cirrus systems
Benefits
Comp & perks- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement